Primary: To evaluate the diagnostic accuracy of point-of-care ultrasound for the identification of elbow fractures in pediatric patients. We searched MEDLINE, PubMed, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) up until December 1, 2025 for studies involving pediatric patients presenting to the emergency department with suspected elbow fractures, who underwent POCUS. Studies were assessed for risk of bias using the QUADAS-2 framework. The primary outcome of interest was the ability of POCUS to accurately detect elbow fractures in terms of sensitivity and specificity. Nine studies were reviewed and included in the meta-analysis encompassing 1444 patients. POCUS demonstrated a sensitivity of 92.7% (95% CI: 87.9%-95.8%) with a specificity of 84.5% (75.4% to 90.7%). Once sample size was accounted for, the estimated heterogeneity between studies was small. The studies analyzed were generally of good quality with the reference standard and flow and timing being the main areas subject to bias. The findings of this systematic review and meta-analysis support the conclusion that POCUS is an effective tool in the diagnosis of pediatric elbow fractures presenting to the ED. Given its high sensitivity, a negative POCUS examination may be used to reliably rule out pediatric elbow fractures where the clinical suspicion is low. The moderately high specificity means that positive findings may require confirmatory radiography in cases where clinical findings are less convincing.
As a clinical database, the newly released public use data set (PUD) from the Pediatric Emergency Care Applied Research Network (PECARN) Registry contains rich patient-level and operational granularity unavailable in large administrative databases. To determine whether the PECARN Registry PUD population is representative of the broader cohort of patients treated at US children's hospitals, we sought to compare the PECARN Registry PUD to the widely used Pediatric Health Information System (PHIS) administrative database across demographic, system-based, and clinical ED visit characteristics. We analyzed 14,875,508 PHIS and 3,196,288 PECARN Registry PUD patient emergency department (ED) encounters from 2017 to 2021. We compared the databases for patient demographics, ED visit characteristics, and diagnosis groupings, as well as the number of medications administered, imaging rates, and diagnosis-specific quality indicators using standardized effect size differences. As 9 of the PECARN Registry PUD hospitals were also included in the PHIS database, we performed a secondary analysis to determine if the overlap inclusion of these 9 hospitals influenced effect sizes, comparing PHIS data from the 9 PECARN Registry PUD hospitals against PHIS data for the remaining non-PECARN Registry PUD hospitals. Nearly all effect size difference comparisons between PHIS and the PECARN Registry PUD were classified as small (Cohen's h <0.2). Only the proportion of non-Hispanic patients (68.0% vs. 77.2%; Cohen's h: 0.208, 99% CI: 0.206, 0.210) and head injury visits with CT scans (23.5% vs. 15.6%; Cohen's h: 0.200, 99% CI: 0.190, 0.211) had moderate effect size differences (Cohen's h 0.2 to 0.5) that did not dissipate in the secondary analysis. Comparisons between the clinical PECARN Registry PUD and administrative PHIS databases demonstrated substantial agreement, suggesting that the PECARN Registry PUD is generalizable and representative of national children's hospital populations.
Our study objective was to describe our experience with POCUS-guided hydrostatic reductions of ileocolic intussusception performed by a PEM physician at the bedside in the pediatric emergency department (PED). We describe a case series of children aged 3 to 36 months with ileocolic intussusception in the PED who received a bedside POCUS-guided hydrostatic reduction between May 2022 and November 2025 in our secondary care hospital. Data collected included the time from presentation to successful POCUS-guided hydrostatic reduction, success rate, complications, and 24-hour recurrence. A total of 9 bedside POCUS-guided hydrostatic reductions were performed in the PED by a PEM provider. Successful reduction was achieved in 8 out of 9 (88.9%) cases. The median time from PED arrival to successful POCUS-guided reduction was 1.69 hours (interquartile range 1.04 to 2.45). No complications or 24-hour recurrences occurred. One unsuccessful case was later identified to have a lead point requiring definitive surgical repair. Our case series of POCUS-guided hydrostatic reduction performed by a trained PEM physician at the bedside in the PED appears to highlight a safe and expedient form of treatment for ileocolic intussusception. This approach eliminates radiation exposure and may shorten time to intervention in certain cases, particularly in settings without dedicated pediatric radiology services. Further larger studies are needed to validate our findings.
Children with medical complexity (CMC) are defined by the presence of significant chronic health problems that affect multiple organ systems, often requiring medical technology, and result in functional limitations and high health care needs, including frequent emergency department (ED) visits. CMC are an estimated 1.5% of the pediatric population in the United States, yet account for 20% of pediatric ED encounters and 33% of total pediatric health care costs. Beyond high utilization, significant challenges in providing high-quality emergency care for CMC have been identified. Communication with other providers and caregivers, extended treatment times, and limited access to data are among major challenges when caring for CMC in the ED. Insights have emerged in recent years to both (1) reduce the need for emergency care through targeted ambulatory care programs, and (2) improve quality of care when CMC do present to the ED. For example, access to next-day ambulatory appointments and 24/7 access to known providers are successful outpatient strategies to reduce ED visits, while efforts for improving care within the ED have focused on the ability to improve access to critical health information for emergency providers through emergency care plans. Future work may include leveraging electronic health records and artificial intelligence to create and manage emergency care plans while improving portability. As this population of children continues to grow, it will be imperative for emergency medicine providers to invest in collaborative care models that prevent acute illness exacerbations, while supporting innovative models to promote high-quality emergency care for this medically and socially vulnerable population.
We sought to describe variation in emergency department (ED) volume of pediatric critical illness encounters, and to assess the geographic proximity of encounters at low-volume EDs relative to high-volume EDs. We conducted a retrospective cohort study of the Healthcare Cost and Utilization Project State Emergency Department and Inpatient Databases for 5 states from 2018 to 2022. Critical illness was defined as death, cardiopulmonary resuscitation, or endotracheal intubation in the ED or on hospital day 0 or 1 or ED critical care time billing. We calculated the ED-level incidence of critical illness and dichotomized EDs into low- or high-volume at the 75th percentile of volume for each state and year. We determined how many encounters at low-volume EDs occurred within a 15-minute drive of a high-volume ED. Of 14,313,896 pediatric ED encounters across 569 EDs, 40,483 (0.3%) were critical. The median ED managed 1,932 pediatric visits each year (interquartile range [IQR] 680 to 5,068) and 5 (IQR 1 to 14) with critical illness. We identified 181 (31.8%) EDs with a calendar year with no pediatric critical illness. We found 1,557 (16.8%) critically ill children were managed in low-volume EDs within a 15-minute drive of a high-volume ED. Most EDs infrequently care for critically ill children, and a minority of these encounters could be realistically diverted to high-volume EDs. Direct transport to high-volume centers is unlikely to be a universal strategy for ensuring access to high-quality emergency care for critically ill children.
Adolescents and young adults (AYA) comprise 50% of sexually transmitted infections (STIs) diagnosed annually. AYA frequently access emergency departments (EDs) for health care. Thus, the ED could be a strategic venue for the diagnosis and treatment of STIs. Cost-effectiveness analysis examining screening strategies for Chlamydia trachomatis and Neisseria gonorrhea (CT/GC). Decision analytic cost-effectiveness model. Six pediatric EDs. AYA 15 to 21 y of age seeking acute care at pediatric EDs. 1) Usual care, 2) targeted screening (using a computerized sexual health survey), and 3) universally offered screening. Cost in 2024 US dollars and effectiveness measured as STIs detected and successfully treated. Secondary effectiveness outcome metric: quality-adjusted life-years (QALYs). The cost perspective is the direct health care sector, and the time horizon is lifelong. Targeted screening was the most effective and most costly (incremental cost-effectiveness ratio [ICER] of $517 per case detected and successfully treated). In a secondary analysis using QALYs lost for long-term complications of untreated CT/GC, targeted screening had an ICER of $23,320/QALY. In this analysis, usual care was dominated, being more costly and less effective than universally offered screening. In subgroup analyses of female versus male, only cohorts using $/QALY, targeted screening remained highly cost-effective for females ($6,389/QALY) compared with universally offered screening but was not cost-effective in males. Targeted screening is a highly cost-effective strategy for detecting and treating STIs in adolescents seeking pediatric ED care compared with universally offered screening, with an ICER of $517 per case detected and treated. When considering quality of life for female- versus male-only subgroups, screening for males becomes less clear.
Gender-diverse patients frequently encounter health care discrimination, contributing to delayed care and worse outcomes. Simulation offers a safe environment to integrate trauma-informed, gender-affirming care into high-acuity training. We developed a 1-hour simulation for pediatric emergency medicine (PEM) fellows combining management of toxic shock with affirming communication and trauma-informed practices. The case features a 13-year-old nonbinary patient presenting with abdominal pain, ultimately diagnosed with toxic shock from a retained tampon. A high-fidelity mannequin capable of intubation and genitourinary exams was used, with a standardized actor voicing the patient. Learners diagnosed and managed toxic shock including progression to decompensated shock requiring intraosseous access and endotracheal intubation. Performance was assessed using a 10-item critical actions checklist. Learners completed a postsimulation survey assessing confidence in providing gender-affirming care, use of trauma-informed communication, and perceived case effectiveness. The simulation was piloted with PEM fellows and is adaptable to pediatric or emergency medicine residents, attendings, and interprofessional teams. Ten PEM fellows piloted the case. Across 2 sessions, learners completed 9/10 critical actions, with consistent omission of asking pronouns until prompted. All participants correctly diagnosed and managed toxic shock, with surveys indicating increased confidence in providing affirming, trauma-informed care. Seventy percent rated the case very effective and 30% rated it extremely effective in preparing participants to interact with patients using trauma-informed care principles. This case demonstrates how high-stakes resuscitation training can incorporate equity-focused communication objectives. We offer a complete, educator-facing resource with case materials, script, debriefing guidance, and assessment tools to support adoption.
Pediatric head injury is a frequent cause of emergency department neuroimaging worldwide and a major contributor to health care utilization. Although most children with minor head trauma do not sustain clinically important traumatic brain injury (ciTBI), the risk of acute complications necessitates accurate risk stratification. A central challenge is balancing the need to reliably exclude ciTBI against the potential harms of ionizing radiation. Despite high-sensitivity clinical decision rules, computed tomography (CT) remains the dominant imaging modality, with utilization rates approaching 40% in some settings. Current research focuses on AI-based triage tools, enhanced injury registries, and international efforts to standardize imaging thresholds. A narrative literature review evaluated trends in CT utilization in pediatric head trauma, AI-based triage tools, and the emergence of rapid MRI. Findings are extrapolated from recent years and compared with historical data. Only peer-reviewed, English-language studies were included. The implementation of validated clinical decision rules - primarily PECARN - has contributed to a > 25% decline in unnecessary CT utilization in the pediatric head trauma population over the past decade. This reduction is attributed to the widespread adoption of evidence-based risk stratification, structured observation pathways, and parent-shared decision aids, which together maintain a high negative predictive value (NPV) > 99.9%. Emerging technologies including AI triage tools and rapid MRI are promising adjuncts but are not yet established standards of care. The PECARN algorithm with explicit age stratification safely reduces unnecessary neuroimaging, with no increase in readmissions for missed bleeding. Best practice involves applying PECARN criteria alongside careful clinical observation, shared decision-making, and the use of ultra-low CT or rapid MRI when imaging is indicated. Not applicable.
Prolonged immobility contributes to pediatric intensive care unit (PICU)-acquired weakness and postintensive care syndrome (PICS). Early mobilization (EM) shows feasibility and potential benefits in adults, and pediatric experiences suggest safety, though data are limited and practice varies. There is a wide variability in Italy regarding EM practices. Thus, we aimed to develop consensus statements to standardize EM across Italian PICUs today while respecting local variability. This project was conducted by a 20-member multidisciplinary panel of Italian PICU experts, including nurses and physiotherapists. The project was endorsed by the Italian Society of Neonatal and Pediatric Anesthesia and Intensive Care (SARNePI). A comprehensive search (2010-2015 July 2025) in PubMed, CINAHL, and PEDro was conducted. Eligible studies included prospective and retrospective studies, systematic reviews, meta-analyses, and guidelines. Nine EM research areas were defined; Statements were drafted using a Quaker-based consensus methodology and voted using the RAND/UCLA appropriateness method. From 8380 records, 113 studies met eligibility. Twenty-two statements and four tables were drafted; 20 statements and three tables achieved strong agreement in the first round. The remaining two statements and one table were revised and were classified with weak agreement. Attendance was 93% at online meetings. This EM consensus provides standardized, implementable statements to guide EM adoption across Italian PICUs while accommodating local practice differences; future work should focus on validation, implementation, and dissemination. • Prolonged immobility in the PICU is one of the modifiable factors associated with PICU-acquired weakness, delirium, and post-intensive care syndrome. • In Italy only 15% of patients admitted to PICU receives Early Mobilization practices with great variability across PICUs. • 22 pragmatic statements and four tables have been developed to promote standardized EM interventions across Italian PICUs, while accounting for variability of practices and equipment. • The provision of graded Early Mobilization, responsive to the child's condition and severity of illness, may promote functional recovery both during and beyond the PICU stay.
Acute encephalitis is a serious neurological emergency in children, characterized by altered consciousness and brain dysfunction. Prompt recognition and management are essential to reduce morbidity and mortality. This study aimed to determine the prevalence and identify clinical and paraclinical factors associated with mortality and neurological sequelae among children with acute encephalitis admitted to a pediatric intensive care unit (PICU). A retrospective cohort study was conducted over 17 years (2008-2024) in the PICU of Hédi Chaker University Hospital, Sfax, Tunisia. Cases were defined according to International Encephalitis Consortium criteria. Of 2,240 PICU admissions, 58 children (2.6%) met inclusion criteria, representing a mean of 3.4 cases per year over the 17-year study period in this tertiary care PICU. Median age was 5 years; 55.2% were male. Common presentations included seizures (82.8%), altered consciousness (69.0%), and fever (82.8%). Among the 46 patients who underwent MRI, neuroimaging abnormalities were detected in 35 (76.1%). Etiology was identified in 81.0% of cases (47/58). Mortality was 20.7% (12/58), and among the 46 survivors, 9 (19.6%) developed neurological sequelae. On univariate analysis, abnormal movements (p = 0.010) and need for supplemental oxygen (p = 0.027) were significantly associated with sequelae, while age under 1 year, seizures at admission, abnormal CT findings, and requirement for advanced resuscitation measures were associated with mortality. Pediatric acute encephalitis carries substantial mortality and morbidity. Early diagnosis, comprehensive etiological investigation, and timely intensive supportive care are essential to improve outcomes. Prevention through immunization and enhanced surveillance should be prioritized.
Polytrauma is defined by the presence of multiple traumatic injuries and poses a significant global health concern due to its associated morbidity. Clear guidelines or recommendations for the medical or surgical management of pediatric polytrauma patients are currently lacking. National Survey of the Management of Paediatric Polytrauma was conducted to clarify and delineate the current national standards in the care paediatric polytrauma patients. We conducted a survey among senior physicians from the Italian Society of Pediatric Surgery and the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care. The survey focused on the management of pediatric polytrauma and compared practices between pediatric and hybrid hospitals, as well as between high- and low-volume centers. A national survey of 52 institutions revealed that 33% were paediatric hospitals and 67% were hybrid institutions treating adult patients. We found that 89% of the institutions had a dedicated paediatric emergency department, and 44% had a senior paediatric surgeon on call. Most hospitals had a dedicated paediatric intensive care unit, 72% had a multidisciplinary trauma team, and 94% had an internal protocol for paediatric polytrauma management. We found no significant differences in the number of second-level paediatric emergency departments, availability of paediatric surgeons, multidisciplinary trauma teams, or imaging modalities. High-volume centres had a higher annual incidence of polytrauma than low-volume centres. The study provides important insights into the current state of paediatric polytrauma management in the Italian healthcare system. The study emphasised the crucial need for standardisation, specialised training, and the development of evidence-based guidelines. The proposed national trauma registry will be instrumental in facilitating this process and improving the quality of care for paediatric polytrauma patients in Italy. Further research examining the effect of volume, training, and guideline implementation on patient outcomes will significantly enhance this field.
Ambulatory surgery has become the dominant model of surgical care in the United States as surgical procedures increasingly shifted from inpatient to outpatient sites of practice. Similar growth in volumes has been observed in pediatric practice. Investigators have highlighted the challenges and opportunities in this current climate, including increasing medical and procedural complexity, difficulties matching pediatric-specific resources to meet the child's perioperative needs and unique risk profile, and limited availability of pediatric ambulatory surgical and anesthesia guidelines of care. Further, they call out the complete lack of pediatric outcomes data to help inform the creation and modification of national care guidelines. To address these challenges, we chose to complete a comprehensive, single center retrospective review of our process, outcome, and balancing metrics contained in our EMR from our free-standing pediatric ambulatory surgery center (ASC) since its opening in July 2010 through December 2024. A commercial software system extracted de-identified, aggregated health data from the system's EMR. The data are processed and presented in statistical process control charts. This methodology allows clinicians to distinguish between common cause and special cause variation. Patient and procedural acuity increased as the system matured via lower age cutoffs and higher ASA physical status scores. This higher acuity was managed with a dynamic and evolving screening process, resulting in no change in unplanned emergency visit or hospital admissions. The COVID-19 pandemic had profound impacts on ASC operations and case mix, including a temporary closure. This retrospective, observational assessment created a detailed picture of our ASC practice changes over time. A pediatric-specific ASC with appropriate patient selection processes, practice guidelines, and clinical expertise successfully mitigated the risk of complications. These results are not generalizable to non-academic, community ambulatory facilities due to the unique characteristics of our pediatric-specific academic center.
Pediatric in-hospital cardiac arrest (IHCA) events leading to extracorporeal cardiopulmonary resuscitation (E-CPR) most often occur in the ICU in cardiac patients. Since there is little information about using E-CPR for pediatric IHCA in the emergency department (ED), we aimed to describe this population. The American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) registry of pediatric IHCA, 2000-2023, a retrospective study. EDs in hospitals contributing to the GWTG-R registry. Children less than 18 years old experiencing index IHCA events in the ED where E-CPR was deployed to achieve return of circulation (ROC). Only cardiac and noncardiac illness categories were included. None. We identified 51 children with a median (interquartile range [IQR]) age of 2 years (IQR, 0.3-5 yr). Pulseless electrical activity was the initial pulseless rhythm in 24 of 46 patients (52%), and pulseless ventricular tachycardia in four of 46 patients (9%). Median CPR duration was 68 minutes (IQR, 48-92 min), with a median number of epinephrine doses being 12 (IQR, 7-19). Nonsurvival vs. survival was associated with greater use of IV calcium (28/30 vs. 8/12; difference 35% [95% CI, 8.2-58.2%]; p = 0.01). Overall survival was 17 of 51 (33.3% [95% CI, 22.0-47.0%]). Cardiac, as opposed to noncardiac underlying diagnosis, was associated with a higher percentage of successful E-CPR with ROC (26/27 vs. 18/24; difference, 21% [95% CI, 1.8-45%]; p = 0.025). In the GWTG-R registry of pediatric IHCA, covering 23 years, E-CPR deployment for IHCA in the ED was reported 51 times. Overall survival to discharge occurred in one-third of cases. We also noted that an underlying cardiac disorder was associated with higher proportions achieving ROC and discharge survival. Further studies are needed to better understand this population and see whether there are missed opportunities in the ED, beyond the median of one case per year, when E-CPR could have been deployed.
To characterize rates of low-acuity emergency medical services (EMS) transports in children and identify factors associated with this status within a regional EMS system. We performed a retrospective study of children (<18 years) transported by 242 EMS agencies to one of 17 hospitals between 2014-2023. Our outcome was a low-acuity status, defined as an ED discharge without advanced prehospital or ED interventions, medications beyond non-opioid analgesics or antipyretics, imaging or blood testing. We characterized rates of low-acuity encounters and used elastic-net penalized logistic regression to identify factors associated with this outcome. Of 68,489 transports, we identified 5,229 encounters meeting low-acuity status (7.6%). These encounters were more common in younger children (median age 3.5 years) and were most often related to non-major trauma (28.7%), fever/general illness (20.6%), and seizure (19.8%), with most presenting to pediatric hospitals (79.7%). In multivariable modeling, low-acuity status was less likely in older ages (relative to 1 year of age) and among encounters for children with abnormal vitals or mental status. These events were more likely in encounters for children with seizure, fever/general illness, and neurologic presentations. The model showed moderate discrimination (area under the receiver operating characteristic curve 0.74, 95% confidence interval [CI] 0.734-0.748; specificity 70.9% [95% CI 70.6%-71.3%] and negative predictive value 95.9% [95% CI 95.7%-96.0%]). Approximately 8% of pediatric EMS transports met our criteria for low-acuity illness. These findings highlight the need for prospective study and system-level strategies to safely identify and manage low-acuity pediatric EMS encounters.
Acute bloody diarrhea (hematochezia) in children is traditionally associated with invasive bacterial infection, but its etiologic spectrum is increasingly recognized as heterogeneous. We aimed to characterize the etiologic distribution of acute bloody diarrhea in a pediatric emergency department and to compare the diagnostic yields of multiplex gastrointestinal PCR and conventional stool testing. In this prospective observational study conducted between July 2018 and July 2019, consecutive children aged 0 to 18 years presenting with visible blood in stool (hematochezia) to a tertiary pediatric emergency department were enrolled. Disease severity was assessed using the Clinical Dehydration Scale (CDS) and the modified Vesikari score. All stool samples were tested with conventional methods (culture, antigen for rotavirus/adenovirus, microscopy) and a 22-target commercial multiplex gastrointestinal PCR panel. The contribution of multiplex PCR was analyzed as a descriptive diagnostic yield rather than as a predictor in a regression model, and a multivariable logistic regression model containing clinical variables only was used to test whether clinical severity independently predicted bacterial etiology. A sensitivity analysis used a stricter culture-confirmed definition of bacterial etiology. Eighty-three children were enrolled (median age 48 mo, IQR 21 to 84; 55% male). At least 1 enteropathogen was detected in 62 patients (74.7%). A bacterial pathogen was identified in 37 of 83 patients (44.6%), a viral-only infection in 14 (16.9%), a parasitic infection in 11 (13.3%), and a mixed viral-bacterial co-detection in 4 (4.8%). Of the 37 bacterial detections, 10 (27.0%) were identified by stool culture alone, 22 (59.5%) by multiplex PCR alone, 1 (2.7%) by both culture and PCR, and 4 (10.8%) by combined antigen and PCR in mixed infections. In the multivariable logistic regression model, none of CDS ≥5, fever, continuous modified Vesikari score, or recent antibiotic use was independently associated with bacterial etiology. Culture and PCR were complementary: 27.0% of bacterial pathogens were detected only by culture despite a negative bacterial PCR target. Pediatric acute bloody diarrhea is etiologically heterogeneous: fewer than half of the presentations had a bacterial etiology, and clinical severity alone did not reliably identify those with bacterial infection. Multiplex PCR expanded-but did not replace-stool culture, with more than a quarter of bacterial pathogens detected only by culture. Clinical management of children with bloody diarrhea should combine maintained clinical vigilance with comprehensive microbiological testing (stool culture plus multiplex PCR).
This study used quality improvement (QI) methodology to safely introduce propofol for use in pediatric procedural sedation across a multisite emergency department (ED) system and to evaluate its impact on length of sedation, length of stay (LOS), and serious adverse events (SAEs). We conducted a QI initiative across 4 pediatric EDs within a quaternary children's hospital network. A multidisciplinary team used the Define-Measure-Analyze-Improve-Control (DMAIC) framework to develop and implement a standardized propofol sedation protocol for short procedures in low-risk patients. Interventions included protocol development, multidisciplinary education, simulation training, electronic medical record (EMR) order set modifications, and phased site rollout. The primary outcome measure was median length of sedation. Secondary outcomes included ED LOS and proportion of sedations using propofol. The balancing measure was airway-related SAEs. All outcomes were analyzed using statistical process control charts and nonparametric testing. During the study period, 2368 children underwent procedural sedation with ketamine (2251) or propofol (117). Median length of sedation for all sedations showed no special cause variation. However, propofol sedation duration was significantly shorter than ketamine across sites (18 to 24 vs. 33 to 52 min; P < 0.001). At the primary site, propofol sedation was shorter than ketamine sedations performed within propofol scope (23 vs. 32.5 min; P < 0.001). ED LOS was shorter for propofol sedations at the primary and secondary sites. SAE rates remained low and stable, with propofol‑associated SAEs occurring in 2.6% of cases. Propofol accounted for 4.9% of all sedations and 20% of sedations among eligible patients. Using QI methodology, propofol was feasibly and safely implemented across a multi‑site pediatric ED system. While the overall length of sedation did not change, propofol use within a defined clinical scope was associated with shorter length of sedation and LOS for selected patients, providing a reproducible framework for implementation.
Supraglottic airway devices (SADs) have become integral to pediatric anesthesia, offering a less invasive alternative to endotracheal intubation with advantages in ease of insertion, hemodynamic stability, and reduced airway trauma. Various SADs, such as the classic laryngeal mask airway (LMA), ProSeal LMA, I-gel, and Ambu AuraOnce are available, each differing in design, seal pressure, and clinical indications. Despite their widespread use, practice patterns among anesthesiologists regarding SAD selection, insertion techniques, and perioperative management in pediatric patients vary considerably, often influenced by training, institutional protocols, and device availability. This study aimed to assess the current trends, preferences, and clinical practices related to the use of SADs among anesthesiologists managing pediatric patients. A cross-sectional, questionnaire-based study was conducted among anesthesiologists working in tertiary-care hospitals, pediatric surgical centers, and academic institutions across India. A structured, validated Google Form was circulated electronically between March and August 2025. The questionnaire included sections on demographic data, years of anesthesia experience, types of SADs commonly used, criteria guiding device selection, perceived advantages and complications, and frequency of use across elective and emergency procedures. Data were analyzed using descriptive statistics and Chi-square tests for association. Out of 248 respondents, 232 (93.5%) reported routine use of SADs in pediatric anesthesia. The I-gel was the most frequently used device (64.6%), followed by the ProSeal LMA (21.8%) and classic LMA (10.7%). Experience significantly influenced device preference (P < 0.01): anesthesiologists with over 10 years' experience favored ProSeal LMA for its higher seal pressure, whereas younger practitioners predominantly used I-gel due to ease of insertion and single-use design. Most respondents (71.9%) preferred SADs for short elective procedures, while 19.2% used them in emergencies. Common complications included minor airway leaks (14.3%) and postoperative sore throat (8.5%), with no reports of aspiration. Institutional training and device availability were cited as key determinants of choice. The I-gel has emerged as the preferred SAD among anesthesiologists in pediatric practice, primarily due to its user-friendliness and safety profile. Although traditional LMAs remain relevant, trends indicate a gradual shift toward second-generation devices offering better sealing and gastric access. Continuous training and evidence-based guidelines could further optimize pediatric airway management. Résumé Contexte:Les dispositifs supraglottiques (DSG) sont devenus indispensables en anesthésie pédiatrique, offrant une alternative moins invasive à l’intubation endotrachéale.Objectifs:Évaluer les tendances actuelles, les préférences et les pratiques cliniques liées à l’utilisation des DSG parmi les anesthésistes prenant en charge des patients pédiatriques.Matériels et Méthodes:Une étude transversale par questionnaire menée auprès des anesthésistes en Inde entre mars et août 2025.Résultats:Sur 248 répondants, 232 (93,5 %) utilisent régulièrement les DSG. Le I-gel était le dispositif le plus utilisé (64,6 %), suivi du ProSeal LMA (21,8 %) et du LMA classique (10,7 %). Les complications étaient mineures : fuites d’air (14,3 %) et mal de gorge (8,5 %), sans cas d’inhalation.Conclusion:Le I-gel est devenu le DSG préféré en pratique pédiatrique grâce à sa facilité d’utilisation et son profil de sécurité. Une formation continue et des recommandations fondées sur les preuves optimiseraient la prise en charge des voies aériennes pédiatriques.
Status epilepticus (SE) treatment is more effective when benzodiazepines (BZDs) are given soon after SE diagnosis. The Quality Improvement in Time to Treat Status Epilepticus (QuITT-SE) trial is a multicenter, randomized, stepped-wedge effectiveness-implementation hybrid study aimed at improving time to SE treatment. We report the QuITT-SE baseline cohort and test the hypothesis that acute seizure emergency episodes treated promptly differ in clinical and demographic features from those with delayed treatment. Data were summarized from 371 consecutive acute seizures episodes treated with a BZD in the inpatient, non-intensive care unit (ICU) setting from 207 individual patients across eight centers per the QuITT-SE protocol. To test our hypothesis, we utilized a multivariable negative binomial mixed effects model with random intercepts to estimate the incidence rate ratios for variables of interest for time to BZD treatment. The median age was 7 years (IQR = 3-12). Nonelective ICU transfers occurred with 26% of episodes, including 13% within 6 h of the episode. The median time from seizure onset to BZD treatment was 6 min (IQR = 4-10), with 74% of all episodes and 63% of SE treated within 10 min. BZD administration was faster when nurses made the treatment decision, when the intranasal (IN) route was used, when the patient received prior rescue medication within 24 h, or with certain elective admission types. Seizures were shorter when BZD administration was faster or when treatment was with IN midazolam versus intravenous lorazepam (median = 8 min [IQR = 6-15] vs. 10 min [IQR = 7-17], p = .04). Patients were less likely to be transferred to the ICU if they received IN midazolam (odds ratio = .3, p = .007). Delayed BZD administration occurs in one third of SE treatment. Prolonged seizures and ICU transfers are associated with modifiable risk factors. Baseline drivers of delayed acute seizure treatment may be addressed using the QuITT-SE interventions, the study of which is currently ongoing.
The burden of disease and costs of respiratory syncytial virus (RSV) infections in children under 5 years in pediatric primary care are not well known. Observational, prospective, and analytical study of children with suspected RSV respiratory infection confirmed by molecular testing. Thirty-seven pediatricians in eight autonomous communities recruited patients aged 0-59 months with suspected RSV infection from November 2021 to January 2024. The data were collected on the day of recruitment and at 14 and 30 days. We evaluated direct and indirect health care costs. Of the 517 recruited children, 206 (39.8%) tested positive for RSV (64.5% for type A; 35.4% for type B; and 2.36% for both A and B). There were significant differences in the proportion of children with dyspnea in the RSV-positive group compared to the RSV-negative group (50.0% vs 31.8%; P < .001). In the RSV-positive group, a higher proportion of infants aged less than 12 months, compared to other age groups, visited the emergency department (39.6% versus 22.5%; P = .010) and required hospital admission (25.0% versus 9.5%; P = .004). Inhaled bronchodilators were administered to 58.4%, inhaled corticosteroids to 9.7%, oral corticosteroids to 11.9%, and antibiotics to 18.3%. In the subset of school-aged children, 69.2% missed at least one day of school (median, 8 days; IQR, 5-14). The total cost per episode was €458, with significant differences between infants (€507) and children aged 1 year or older (€419) (mean difference, €88; 95% CI, 76-99; P < .001). The only differences between autonomous communities were in the use of bronchodilators and the frequency of emergency department visits. Infection by RSV in early childhood places a significant clinical, economic and health care resource burden in out-of-hospital settings, which supports the implementation of effective preventive measures.
We sought to summarize the last 20 years of published research on gender experience and disparities in the emergency medicine workforce. We conducted a scoping review by searching MEDLINE ALL, Embase, Cochrane Central Register of Controlled Trials, and Scopus from 2003 to 2024, to identify original research investigating gender experience and disparities among physicians in emergency medicine in North America. We abstracted study design, sample characteristics, and outcomes. We analyzed data using an ad hoc iterative thematic analysis of the content areas as well as a synthesis of the key findings and research limitations. We identified 5,740 candidate publications and, after exclusions, included 191 (99% observational studies). We identified 15 themes: (1) workforce, (2) childbearing, (3) attrition, (4) evaluations, (5) bias and discrimination, (6) wellness, (7) professional development groups and mentorship, (8) authorship, (9) editorial board membership, (10) research grants, (11) national speakers, (12) awards, (13) leadership roles, (14) academic rank and promotion, (15) financial compensation and one subtheme (pediatric emergency medicine). We mapped these themes to 5 domains: (1) Recruitment and Retention, (2) Culture and Environment, (3) Academic Scholarship, (4) Recognition and Promotion, and (5) Clinical Care and Decisionmaking. There were 3 to 33 publications per theme. The quality of evidence was variable. We found fewer disparities, and improvement over time in the percentage of women academic faculty, women authorship, national speaking, and educational awards. We found consistent evidence of gender disparities disadvantaging women emergency physicians in financial compensation, editorial board membership, executive leadership roles, academic rank, and experiences of gender bias, with little change over time. Although some areas remain understudied, our central findings confirm that gender-based disparities continue to exist among emergency physicians. Future efforts should be redirected toward the development and assessment of interventions that combat these disparities.